Histological Changes Associated with Fetal Maceration

  • Linda M. ErnstEmail author
  • Michael K. Fritsch


The collective changes that occur in the fetal organs and tissues after fetal death in utero are referred to as maceration changes; they differ from pure postmortem autolysis because they occur in utero, in fluid, and at body temperature. The changes of maceration are therefore commonly encountered by the pathologist performing fetal autopsies and examining fetal tissues at the surgical pathology bench. This chapter reviews how the histologic fetal and placental changes of maceration can be used to predict the timing of fetal death in utero, discuss histologic artifacts introduced by maceration, and describe the challenges of assessing pathologic changes in a background of maceration.


Fetus papyraceous Involutional changes Loss of nuclear basophilia Timing of intrauterine death 


  1. 1.
    “Macerate.” Merriam-Webster, Accessed 25 Apr 2018.
  2. 2.
    Genest DR, Singer DB. Estimating the time of death in stillborn fetuses: III. External fetal examination; a study of 86 stillborns. Obstet Gynecol. 1992;80:593–600.PubMedGoogle Scholar
  3. 3.
    Gold KJ, Abdul-Mumin AR, Boggs ME, Opare-Addo HS, Lieberman RW. Assessment of “fresh” versus “macerated” as accurate markers of time since intrauterine fetal demise in low-income countries. Int J Gynaecol Obstet. 2014;125:223–7.CrossRefGoogle Scholar
  4. 4.
    Genest DR, Williams MA, Greene MF. Estimating the time of death in stillborn fetuses: I. Histologic evaluation of fetal organs; an autopsy study of 150 stillborns. Obstet Gynecol. 1992;80:575–84.PubMedGoogle Scholar
  5. 5.
    Genest DR. Estimating the time of death in stillborn fetuses: II. Histologic evaluation of the placenta; a study of 71 stillborns. Obstet Gynecol. 1992;80:585–92.PubMedGoogle Scholar
  6. 6.
    Khong TY, Mooney EE, Ariel I, Balmus NC, Boyd TK, Brundler MA, et al. Sampling and definitions of placental lesions: Amsterdam placental workshop group consensus statement. Arch Pathol Lab Med. 2016;140:698–713.CrossRefGoogle Scholar
  7. 7.
    Parast MM, Crum CP, Boyd TK. Placental histologic criteria for umbilical blood flow restriction in unexplained stillbirth. Hum Pathol. 2008;39:948–53.CrossRefGoogle Scholar
  8. 8.
    Ryan WD, Trivedi N, Benirschke K, Lacoursiere DY, Parast MM. Placental histologic criteria for diagnosis of cord accident: sensitivity and specificity. Pediatr Dev Pathol. 2012;15:275–80.CrossRefGoogle Scholar
  9. 9.
    Royal College of Obstetricians and Gynaecologists and Royal College of Pathologists. Fetal and perinatal pathology: report of a joint working party. London: Royal College of Obstetricians and Gynaecologists; 2001. p. 1–38.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory MedicineNorthShore University HealthSystemEvanstonUSA
  2. 2.Department of Pathology and Laboratory MedicineUniversity of Wisconsin, MadisonMadisonUSA

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